Sporotrichosis

Sporothrix schenckii is a dimorphic fungus. At temperatures lower than the human body temperature the fungus exists in a hyphal form, while at body temperature it exists as a yeast form. In the body, the organism reproduces by budding and forms cigar-shaped yeast cells which can rarely be round or oval. This organism has worldwide distribution in temperate to tropical climates and is endemic to a remote area in Peru. The organism can be found in sphagnum moss, decaying wood, other vegetation, hay, and soil. Infected animals or animals contaminated with infected soil can pass the organism to humans by scratching, biting, or casual contact (10).

The clinical presentation is that of a lymphocutaneous infection presenting as an ulcer after inoculation of the fungus, a respiratory infection that presents as tuberculosis after inhalation of the conida, or an osteoarticular infection that occurs after deeper inoculation or by hematogenous spread. One or multiple joints may be involved. Meningitis can also occur in people who are immunocompromised, such as those with lymphoma or AIDS. Similarly, disseminated disease occurs rarely in patients with AIDS. Diagnosis is confirmed by culture of the organism from aspirated material, tissue biopsy, sputum or body fluid (10).

Treatment will vary depending on the illness. Lymphocutaneous disease can be treated with itraconazole or fluconazole as a second line treatment. Treatment for mild respiratory or osteoarticular infection can start with itra-conazole. Duration of treatment should be one year or longer. Severe pulmonary disease, meningitis or disseminated disease should be treated with amphotericin B, followed by itraconazole suppressive therapy (11,12).